● Normal values are
highly dependent on:
– Age
– lean body mass of
the person
● Normal value ranges
may vary slightly
among different
laboratories.
● Urine creatinine (24hour sample) values
may therefore be quite
variable and can range
from 500 mg/day to
2000 mg/day.
Urine creatinine
Urine creatinine
• Some now
collected for 12,
6 or 4 hours
Used for four-24 hour urine
collection; kept in ice in wash
basin, on Chux.
Serum Creatinine
● A normal (usual)
serum creatinine
value is 0.8 to 1.4
mg/dl. Normal value
ranges may vary
slightly among
different laboratories.
● Females have a
lower creatinine than
males, due to less
muscle mass.
● Note: mg/dl =
milligrams per
deciliter
Azotemia
• an abnormally high level of nitrogen-type
wastes in the bloodstream
•  serum urea (measured by BUN)
•  creatinine often also elevated
• It is caused by conditions that reduce
blood flow to the kidneys.
Urethritis
• a syndrome of inflammation of the urethra
• often called NSU (non-specific urethritis) or NGU
(non-gonococcal urethritis)
• Causes, incidence, and risk factors:
– Usually a sexually transmitted disease (Chlamydia,
gonorrhea, & Ureaplasma urealyticum).
– same organisms that cause urinary tract infections
(for example, E. coli or klebsiella)
– Viral causes of urethritis include herpes simplex virus
and cytomegalovirus.
– may also develop because of a chemical irritation
(such as spermacide in condoms or contraceptive
jelly, cream, or foam)
– Trauma may also cause urethritis.
Urethritis …continued
• classic signs and symptoms of nonspecific urethritis (NSU)
– burning upon urination
– a light discharge
– When heavier, thicker discharge occurs
usually more suggestive of gonorrhea
– At times there may be no discharge at all &
only complaint may be a urethral itch
Urethritis …continued
• Symptoms in men:
– dysuria
– increased urinary frequency or urgency
– itching, tenderness, or swelling in penis and/or
groin area
– fever (rare)
– discharge from penis
(usually moderate,
yellow or clear, and may
or may not be purulent)
– pain with intercourse or
ejaculation
– blood in the urine and/or
semen
Urethritis …continued
• Symptoms in women
– dysuria
– increased urinary
frequency or
urgency
– fever/chills
– nausea/vomiting
– abdominal pain
– vaginal discharge
– PID (pelvic inflammatory disease)
Urethritis: Symptoms in women
…continued
– other infections of reproductive organs
(cervicitis, salpingitis)
– fertility problems
– pelvic pain
– ectopic pregnancy
– complications of pregnancy
•
•
•
•
•
Miscarriage
preterm delivery
premature rupture of membranes
fetal infection
postpartum infection)
Urethritis: Complications May Lead To:
• In men:
–
–
–
–
–
cystitis
pyelonephritis
epididymitis
orchitis
prostatitis
–
–
–
–
–
–
–
PID
cervicitis
salpingitis (infection of the ovaries)
fertility problems
ectopic pregnancy
miscarriage
other complications of pregnancy.
• In women:
Urethritis Tx:
• Current treatment recommendations
usually include Doxycycline (for 7 days)
or azithromycin (Zithromax) as a single
dose.
• All sexual partners during the 30 days
before dx should be notified, examined
and tx prn.
Urethritis Prevention:
• Some causes of urethritis may be
avoided with:
– good personal
hygiene
– practicing safer
sexual behaviors
such as:
• monogamy
• use of condoms).
Nosocomial Infection
• Most common bacterial
infection.
• Catheter-associated
UTIs account for ≈ 40%
of all nosocomial
infections annually.
• > 1 million cases are
reported in hospitals
and nursing homes.
• ≈ 50% of patients
become infected w/i 2
weeks of catherization
Cystitis - acute bacterial
• bacterial
infection of
the
bladder or
lower
urinary
tract
UTI Symptoms:
• pressure in the lower pelvis
• dysuria
• frequent need to urinate
(frequency)
• urgent need to urinate
(urgency)
• nocturia
• Abnormal urine color
(cloudy urine)
• hematuria
• foul or strong urine odor
• Young children with UTIs
may only have a fever, or
even no symptoms at all.
• Additional symptoms that
may be associated with this
disease:
–
–
–
–
–
–
–
–
Sexual intercourse, painful
Penis pain
Flank pain
Fatigue
Fever
Chills
Vomiting
Mental changes or
confusion (Note: in elderly
people, mental changes or
confusion often are the
only signs of a possible
urinary tract infection.)
UTI: Signs and Tests
• Urine sample; know difference between
UA and C&S:
– A urinalysis commonly reveals WBC or RBC
• MDs often order “WBCs > 10,000, get C&S and
GS”
• UA goes to Lab
• C&S goes to Microbiology
– A urine culture (clean catch) or catheterized
urine specimen may be performed to
determine the type of bacteria in the urine and
the appropriate antibiotic for treatment.
UA
Urine analysis uses a thin strip of plastic (dipstick) to
measure the levels of protein, sugar, and ketones in the
urine. The dipstick is impregnated with chemicals that
change color when they react with these substances.
http://www.merck.com/mmhe/resources/multimedia/name/photo.html
All texts and hospital normal lab values vary
slightly.
• Know urinalysis results and significance on page
579, Table 34-2 of your Med/Surg text (Williams &
Hopper, 2003).
• Be able to answer questions like those
presented on page 145 of your Student
Workbook (Williams & Hopper, 2003).
• You should know how to explain the correct
technique to a patient (female or male) when a
UA is needed. Do not be surprised if this is an
essay question on the final exam!
UTI Tx:
• Mild cases may disappear spontaneously
without tx; however, because of the risk of the
infection spreading to the kidneys (complicated
UTI), tx is usually recommended.
• Tx (with antibiotics) promptly in children to
protect their developing kidneys.
• Due to the high mortality rate in the elderly
population, prompt treatment is recommended.
Pharmacology:
• Antibiotics may be used to control the bacterial
infection.
• Patient Education includes explaining the need
to finish the entire course of prescribed
antibiotics.
• Commonly used antibiotics include:
–
–
–
–
–
–
–
Nitrofurantoin
Cephalosporins
Sulfa drugs (sulfonamides)
Amoxicillin
Trimethoprim-sulfamethoxazole
Doxycycline (should not be used under age 8)
Quinolones (should not be used in children)
UTIs: Prevalence
• Because of:
– Constantly shifting landscape of drug resistance
– antibiotic options
– pharmacoeconomic considerations
• urinary tract infection (UTI) continues to be one
of the most frequently diagnosed conditions in
patients presenting to ER & hospital-based
settings.
• UTIs are the leading cause of gram-negative
bacteremia in patients of all ages
• Are associated with a high risk of morbidity &
mortality, especially in the elderly.
UTIs In the Nursing Home
Clinical Practice Guideline
• DISEASE RECOGNITION
– Worsening or new urinary incontinence or urinary
retention
– unexplained new anorexia
– functional decline
• falling
• leaning over in seat
• mental status
changes
• restless
• crying
• agitated
UTIs In the Nursing Home …continued
– Unexplained:
•
•
•
•
•
fever &/or chills
Dysuria
Hematuria
Urgency
frequency
– New flank or suprapubic pain
UTIs In the Nursing Home …continued
• ASSOCIATED RISKS
– Hx of:
• DM
• Immunosuppression
• renal calculi
• renal insufficiency
• previous UTIs
– Known functional or structural urologic abnormalities:
• BPH
• kidney stones
• estrogen deficiency
• retention
• cystocele
UTIs In the Nursing Home …continued
– Urologic procedure or discharge from hospital
within past 2 weeks
– Presence of indwelling Foley catheter
– Bowel and bladder incontinence
– Multiple Sclerosis (MS)
– spinal cord injury
– HIV
UTIs In the Nursing Home …continued
• Whenever possible catheters should be
changed:
– Always before
collecting urine
sample for UCS
– every 2-4 weeks
– When UCS
results indicate
UTI
Myth: Catheterized patients who develop
infections exhibit classic S&S
• Fact:
– Typically do not exhibit classic S&S such as
frequency & dysuria.
– Because catheter prevents infectious
urethritis & bladder distention.
– Even pts. with severe bacteriuria may be
asymptomatic.
Nursing, Oct2001, Vol. 31 Issue 10, p72, 1/2p
Myth: Providing nursing staff with
information about nosocomial UTIs is
not an effective way of decreasing
these infections.
• Fact:
– When nursing staff at a VAMC were given
education session on basic urinary cath care
& continual unit-specific feedback about their
UTI rates, they intervened effectively.
• Infection rates  decreased and about $403,000
was saved because of shorter LOS and reduced
morbidity.
Nursing, Oct2001, Vol. 31 Issue 10, p72, 1/2p
UTI in Combination With Other Dx
• Percutaneous Endoscopic
Gastrostomy PEG tube placement (for
feeding) does not prevent aspiration
• 16.7% (1 in 6 patients) aspirate
• Pts with both a history of aspiration &
a UTI have a 48.4% probability of
dying 1 week post-procedure
(Roche, Geriatrics, 2003, Vol. 58, #11).
Pyelonephritis
• Most kidney
infections result
from UTI that are
not successfully
treated.
Nursing, Nov2003 Supplement, Vol. 33, p28-28, 1/5p
Practice for the NCLEX-PN
by CramExam
A client is receiving Pyridium (phenazopyridine
hydrochloride) for a urinary tract infection. The
client should be taught that the medication may:
a)
b)
c)
d)
Cause diarrhea
Change the color of her urine
Cause mental confusion
Cause changes in taste
Practice for the NCLEX-PN
by CramExam
A client is receiving Pyridium (phenazopyridine
hydrochloride) for a urinary tract infection. The
client should be taught that the medication may:
b) Change the color of her urine
Q: A nurse is assisting in planning a
teaching session with the female client dx
with urethritis resulting from infection with
Chlamydia. Plan would include:
• The most serious complication of this infection is sterility
• The infection can be prevented by using spermicide to
alter the pH in the perineal area
• Medication tx s/b continued for 2 weeks w/o interruption
• Sexual partners during the last 12 months should be
notified & tx
Saunders Comprehensive Review for the NCLEX-PN Exam, Ed. 2, 2003,
page 738.
Q: A nurse is assisting in planning a
teaching session with the female client dx
with urethritis resulting from infection with
Chlamydia. Plan would include:
• The most serious complication of this infection is sterility
Saunders Comprehensive Review for the NCLEX-PN Exam, Ed. 2, 2003,
page 738.